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In reply

Matthys and De Meyere disagree with the conclusion of our article that combining clinical findings and a rapid streptococcal test is a valid approach for the management of pharyngitis in adults.¹ However, several reasons justify that it is an efficient strategy to identify and treat adequately the few patients with pharyngitis who need antibiotic therapy:

1. We agree that clinical findings alone are unreliable to diagnose streptococcal pharyngitis. Our study included only patients meeting 2 to 4 clinical criteria, corresponding with a 24% to 60% probability of streptococcal pharyngitis. This diagnostic uncertainty creates a typical situation in which a diagnostic test significantly changes the posttest probability of streptococcal infection and reduces unnecessary antibiotic prescribing.
   
2. As discussed in our article, sensitivity and positive predictive value of rapid streptococcal tests vary between studies, while all studies agree on a high specificity greater than 95%.² The positive predictive value depends on the . . . [Full Text of this Article]

RELATED ARTICLE

Management of Acute Pharyngitis in Adults: Reliability of Rapid Streptococcal Tests and Clinical Findings
Jean-Paul Humair, Sylvie Antonini Revaz, Patrick Bovier, and Hans Stalder
Arch Intern Med. 2006;166(6):640-644.
ABSTRACT | FULL TEXT